John Orchard's Sports Injury Site
For transfer to my new extended site on sports injuries in Australia, click:
http://www.injuryupdate.com.au
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John Orchard's Sports Injury Site For transfer to my new extended site on sports injuries in Australia, click: http://www.injuryupdate.com.au
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For more information, visit: http://www.injuryupdate.com.au/issues/aprotinin_injections.php What is
Aprotinin? Aprotinin is a protein that is obtained and
purified from cow’s lungs. It has been used in medicine for many years as a
drug in heart surgery, and is available in Australia under the brand name
TRASYLOL. How are
tendon injuries treated? Tendon injuries (or tendonitis, tendinosis or
tendinopathy) have been traditionally treated in three stages according to
severity: (1) initially, graded strengthening exercises under the supervision of
a physiotherapist; (2) cortisone injections to the outside of the tendon; (3)
surgery to remove damaged portions of the tendon and repair any ruptures. The
problem with this management plan has been the lack of success of cortisone
injections and surgery, in many cases (although they have been successful in
others). How do
cortisone injections work? Cortisone is a powerful anti-inflammatory drug,
related to the anti-inflammatory tablets that are often used in sports medicine
(like Voltaren, Naprosyn etc.) Inflammation is the means by which tendon
injuries become painful and swollen. Cortisone injections are generally very
good at making tendon injuries less painful and swollen in the first 1-2 weeks
after injection. The two major problems they have is that the effects often
quickly wear off and there is a small risk of tendon rupture after the
injection. The risk of rupture is particularly relevant for big tendons like the
achilles tendon that have no other tendons nearby to help with their job if they
snap. Cortisone injections still have a role in the treatment of tendon
injuries, but there is a need for alternatives in patients where they fail, or
who are unwilling to take the risk of tendon rupture. How does
aprotinin work? Aprotinin inhibits (stops) some of the enzymes in
the body that break down protein, including tendon substance. Therefore, in
theory, it might be able to reverse some of the tendon damage in a chronic
tendon disorder. A recent European study of patella tendonitis has been
published that showed aprotinin injections had a better success rate than
patients who were injected with cortisone or a placebo (in the same study). Are there
any side effects? The major side effect (less than 1 in 500
people on the first treatment, but 1 in 30 if treatment is repeated within 6
weeks) is allergic reaction to the drug. Allergic reaction can be severe but
can be treated readily at a medical centre. Minor allergies give redness around
the injection site and itching. It would be expected that the risk of tendon rupture after
aprotinin injection would be less than after cortisone injection, but for all
patients with a tendon injury there is a small risk of tendon rupture with
continued activity. How many
injections will I need? The patients in published studies have received two to
four injections, spaced two weeks apart. Multiple injections are probably more
effective but carry a greater risk of allergic reaction. It would be
best to avoid sport or train very lightly for 5 days after an injection as a
general precaution, although there is less concern about training soon after an
Aprotinin injection than a cortisone injection.
Aprotinin is mixed with local anaesthetic, which will numb the area for about 2
hours. Link to TRASYLOL website (to see the normal use for this drug), NB side effects are far LESS for tendon injections than in Cardiac Bypass Surgery where the injection is intravenous (obviously): Links on the web describing the use of Aprotinin for chronic tendon injuries: French article in abstract format citing successful use of Aprotinin for Achilles tendon injuries |